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V.M v. Department of Human Services

May 23, 2011

V.M.,
PETITIONER-APPELLANT,
v.
DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES AND UNION COUNTY BOARD OF SOCIAL SERVICES, RESPONDENTS-RESPONDENTS.



On appeal from the Division of Medical Assistance and Health Services.

Per curiam.

RECORD IMPOUNDED

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION

Submitted May 4, 2011

Before Judges Cuff and Simonelli.

Petitioner V.M. appeals from the final agency decision of the Director (Director) of Division of Medical Assistance and Health Services (DMAHS) adopting the initial decision of the Administrative Law Judge (ALJ), which affirmed the decision of respondent Union County Board of Social Services (UCBSS) to deny V.M.'s application for Medicaid benefits. We affirm.

We derive the following facts from the evidence presented to the ALJ.

In January 2002, V.M. appointed two of his children, P.M. and C.S., as co-attorneys under a Power of Attorney (POA). The POA authorized the children to control their father's financial interests, sell his real and personal property, and execute his tax returns, among other things. Except for debts and obligations incurred by the children in connection with the POA, there was no provision for their compensation for services rendered to or expenses incurred pursuant to the POA.

In July 2007, V.M. was admitted to a nursing home and rehabilitation center. In August 2007, he applied for nursing home Medicaid benefits and was approved as of July 1, 2007. He will likely require nursing home care for the rest of his life.

V.M.'s home in Westfield was sold in January 2008. He received net proceeds of $202,747.63. In May 2008, P.M. and C.S. filed a verified complaint and order to show cause (OTSC) in the Superior Court, Chancery Division seeking an order authorizing payment for various services they allegedly rendered to their father pursuant to the POA, such as house and yard maintenance and repair, grocery shopping, the paying of bills and running of errands, transportation to family gatherings on birthdays and other events, and the preparation for and negotiation of the sale of V.M.'s home. In total, they sought $102,555 for services rendered at the rate of $15 per hour, and $24,400 for expenses allegedly incurred on V.M.'s behalf between January 22, 2002 and March 2008. They offered no details about the dates and times they rendered the services and who performed which services, and provided no receipts for expenses incurred. Also, they did not advise the court that V.M. was receiving Medicaid benefits at the time of the OTSC, and they did not serve the verified complaint and OTSC on DMAHS or UCBSS.

In a June 11, 2008 order, the court granted P.M.'s and C.S.'s unopposed application and authorized the payment of $102,555.55 for services rendered and $24,400 for expenses incurred. This left a balance from which V.M. paid $2798.24 for attorney's fees, $10,000 for prepaid funeral expenses and $63,775.32 for medical care and nursing home bills.

P.M. and C.S. reported the sale of V.M.'s home to UCBSS, and in September 2008, UCBSS terminated V.M.'s Medicaid benefits effective June 30, 2008, because his resources exceeded eligibility limits at that time. UCBSS notified V.M. that he could re-apply for benefits when his resources were reduced to approximately $10,000.

V.M. re-applied for nursing home Medicaid benefits pursuant to the Medically Needy Program (MNP), N.J.A.C. 10:70-1.1 to -7.3. UCBSS denied the application because V.M. had transferred $126,955 in contravention of N.J.A.C. 10:71-4.10, that is, he transferred assets to his children within the thirty-six month look-back period for less than fair market value (FMV). V.M. appealed, and the matter was transferred to the Office of Administrative Law for a hearing.

The matter proceeded summarily before the ALJ. V.M. argued that (1) the court-ordered transfer issued pursuant to N.J.S.A. 46:2B-8.12 rebutted the presumption established by N.J.A.C. 10:71-4.10(b)6.ii that any transfer of resources during the look-back period was done in order to obtain Medicaid eligibility; (2) the court-ordered transfer barred DMAHS from denying him Medicaid eligibility; and (3) DMAHS's decision is inconsistent with N.J.S.A. 46:2B-8.12. The ALJ rejected these contentions and affirmed the denial of V.M.'s application. She noted that DMAHS neither received ...


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